There seems to be an “epidemic” of
sinus problems in America.Each year,
hundreds of thousands undergo surgery to clear sinuses that are so severely
blocked, often as the result of infections resistant to drug treatment, that
there seems to be no other way out.Millions take antibiotics and other prescription drugs to clear, or
attempt to clear, repetitive infections and/or to alleviate the intense
congestion caused by irritants and allergies.Prescription decongestant drugs, such as the widely-used Seldane, have
been shown to be potentially dangerous when mixed with certain
antibiotics.There are tens of millions
who purchase over-the-counter (OTC) remedies for their symptoms; some of the
OTC drugs, such as those based on pseudoephedrine, can induce insomnia, while
others, such as those based on common antihistamines, induce drowsiness.

Several possible causes for these
sinus problems can be suggested.Direct
irritation of the sinuses might be blamed on cigarette smoking, a practice
undertaken by 48 million Americans.Sinus irritation also arises from those who have used, or continue to
use cocaine by inhalation of the powder (many millions of people in the past
twenty-five years).There are those who
work daily, or at least frequently, in dusty, dirty, or polluted areas, not
just in inner cities, but on some farms, in mines, and in rural factories that
refine natural resources.Abnormalities
of the immune system, leading to allergy and/or reduced ability to fight sinus
infections, may arise from early curtailment of, or the failure to provide any,
breast feeding of infants.Immune
dysfunction can also be the result of exposure to powerful chemicals and drugs,
common nutritional deficiencies, and from irregular habits associated with
eating and sleeping.A further
contributing factor to sinus problems may be lack of vigorous physical
activity: such activity dilates the sinuses and stimulates the circulation of
air and cleansing mucus through the sinuses.All of these might be considered life-style and environmental factors
that are characteristic of conditions for most people in the U.S. during the
second half of the 20th century.Thus,
it is not surprising to find the appearance of widespread nagging sinus
disorders.

There are three problems with the
current remedies—such as drugs and surgery—that are most commonly applied to
treating the disorder.First, they fail
to correct the behaviors that contribute to the sinus problems, or even show
direction towards behavioral modifications, so the disorder recurs.Second, they do not improve the body’s own
mechanisms for rectifying such disorders; rather, they temporarily force a
change that gives symptomatic relief.Third, for some people there are side-effects of drugs and complications
from surgery.

One avenue towards a possible
solution is to rely on traditional medicine: a continually evolving approach to
healthy life that can be traced back to ancient times, but which illuminates
current options for natural health care.Here is an example.

INDIA AND AYURVEDIC MEDICINE

India is the ancient source of our own
language, the source of great art, and the widespread Buddhist religion.From India we have gained the popular yoga
exercises, much of the West’s approach to vegetarian diet, the strategy of
non-violent revolutionary change inspired by Ghandi, and the natural medical
approach known as Ayurveda.

In ancient times, the knowledge of wise living was set down in a
group of teachings (vedas:
collections of knowledge and wisdom), including the one that is the source of
traditional medicine in India—Ayurveda (ayur,
meaning to know.Ayurveda is knowing
the great wisdom, and, thereby, having a long, healthy life; it is often
translated into English as the “science of life”).Today, more than 2,500 years after the earliest records of this
medical system were produced, it is a popular means of health care in India
and, increasingly, throughout the world (1).

Within the system of Ayurveda there is a rich heritage of herbal
knowledge (2).This knowledge, when
applied with the sophisticated system of diagnostics and therapeutics, can be a
powerful tool towards relieving many of the ills that affect us today.As importantly, these effective methods can
be a guiding light towards understanding a healthful lifestyle.

AYURVEDIC UNDERSTANDING OF SINUS DISORDERS

From the point of view of trained
Ayurvedic physicians, many of the sinus problems experienced today have their
root in the digestive system, especially the stomach and upper small intestine,
which directly receives partially-digested food from the stomach.That is to say, the nasal irritants, the immune
system disturbances, and other contributors to sinus problems that we can
identify, are producing frequent symptoms—some of them quite serious—because of
an underlying digestive disorder in many instances.

This digestive problem is described more specifically as a
weakness in the digestive fire; in Ayurvedic terminology (3), the problem is manda agni: dampened ability to
transform and metabolize.Agni is one of the five elements (bhutas) that combine to form the
physical realm and the human body: agni
is the fire element.Within the body
there are many metabolic processes, or agni,
and the one that is particularly of concern here is called the jathar agni, or the metabolic processes
of the stomach and upper small intestine.From the modern scientific viewpoint, one might describe the
hydrochloric acid and other digestive substances in the stomach, as well as the
enzymes fed into the jejunum (upper small intestine) by the pancreas, as the
essential components of digestive capability.The insufficient activity of these digestive fluids corresponds,
roughly, to manda agni.

Why is this a problem in relation to the sinuses?Because the food is not as quickly and as
thoroughly digested as it should be, leading to production of byproducts that
affect the sinuses.According to the
traditional understanding, ingested food becomes divided into two portions: one
is pure (aharaprasada) and is the one
that is used to nourish the body, while the other is the refuse (mala), that which remains after the pure
portion is drawn off.The result of
inadequate digestive fire is that some of the substances that should be
separated and removed from the food end up accumulating.This material, called ama, is unusable for normal physiological processes.These substances contribute to an increase
in phlegm.

In the Ayurvedic system of diagnosis and classification of
imbalances, phlegm is the substance associated with one of three transporting
systems, or humors, called doshas: kapha, pitta, and vata (see: Basics of Ayurvedic physiology).Kapha
is the transporting system for certain fluids (other than blood), collectively
called phlegm.These fluids are
critical to maintaining health.The
normal mucus lining all of the membranes of the body is protective,
lubricating, and cleansing.It could be
said that because of the weakened agni of
the digestive system, kapha has an
overabundance of fluid, including some fluid that is of undesirable
nature.An overabundance is an
imbalance and is unhealthy: the body needs to get rid of it, but the secretion
mechanisms for ridding excess can eventually be overwhelmed.

The fluid has several potential sites for accumulation.The reason that it accumulates in the
sinuses for some people (but elsewhere for others) is because there is a
disturbance there.That disturbance
could be the irritation from ragweed pollen, cigarette smoke, or other
compounds; it could be from the lack of normal movement of air and mucus due to
inadequate exercise; it could be because of the effect of emotions on the
respiratory system. Such causes are the immediate disease-inducing factors,
known to Ayurvedic physicians as nidanas.

Kapha is described as
the dosha of phlegm, which is a
combination of the water and earth elements (water contributes the fluid
quality, earth the murkiness and thickness).The accumulation of phlegm in the sinus area disturbs another of the
three transporting systems: vata.Vata
is the dosha of air.The lungs and sinuses are directly involved
in transport of air, and they regulate the prahna
vata (air vata); there are other
aspects of vata that affect the body
and are regulated elsewhere.The prahna vata becomes agitated by the
obstruction of phlegm, as it is unable to maintain smooth flow (it is said to
be vitiated). When there is a disturbance, the smooth flow is transformed into
an agitated flow, like the wind.Vata is derived from the air and ether
elements (air is the substance, and ether is the space through which the air
flows to yield its fundamental characteristic: movement).

The third transporting system, or dosha, is called pitta,
and this is the transporter of metabolic nutrients and the energy of
metabolism.One aspect of pitta, called pachak pitta, corresponds to digestive fire. Pitta is described as the dosha of fire.In many cases of sinus problems, there is a weakness or
deficiency in pitta (as it manifests
in the agni of digestion), an excess
in kapha (as it manifests in mucus),
and a disturbance of vata (as it
manifests in the breath).Thus, all
three doshas are imbalanced and
contribute to the sinus disorder that is experienced.

Over time, if the accumulation of phlegm and disruption of air
flow continues, it distorts the entire tissue structure of the face.Muscles become tense, nerves become pinched,
and even the bone structure becomes compressed: one experiences tightness and
pain.From the viewpoint of Ayurveda,
this is because the disturbance of the doshas
has led to a distress of the dhatus:
the structural components of the body.There are seven dhatus recognized
by traditional practitioners, including the mamsa
dhatu (muscle), the majja dhatu (nerves),
and the ashti dhatu (bone).It is suggested that the distortion of
facial structures by chronic sinus problems, in addition to maintaining the
sinus congestion, can lead to weakening of vision, premature greying of hair,
and wrinkling of the skin.

MASSAGE THERAPY

An important step in remedying the
chronic sinus disorder is external oeliation, or, more simply, oil massage
(4).This massage will soften the structures
(dhatus) that have been distorted by
the imbalanced transporters (doshas).Head massage (champi) is considered very important in the Ayurvedic system and it
is used to prevent kapha from
accumulating in the head (among other things, used for common cold, sinusitis,
and headaches).For sinus disorders,
the massage is carried out by applying a medicated oil.

Oils in general, and sesame oil in particular, have the ability
to calm the agitated vata dosha.That is because the qualities of this oil
counter the qualities of vata.In fact, oil massage is sometimes called snehana, which means to apply oil to
control vata.Vata
is described as having the qualities (among others) of lightness, coldness,
irregularity, and dryness.By contrast,
the sesame oil is heavy, warming, smooth, and, of course, oily; thus, it
counteracts the excessive impact of vata
characteristics when the vata is
disturbed. Facial massage with oil alleviates the accumulation of kapha and calms the vata.

Medicated oil, such as narayan oil or mahanarayan oil, enhances
the influence of the massage.The herbs
in mahanarayan oil (of which there are about 50) and narayan oil (which has a
smaller number of the herbs) are selected to help soften the obstructions
(distortions of the dhatus) that
occur from long-term dosha
imbalances.The main ingredient of the
narayan oils is shatavari (Asparagus racemosus).The oil is also used topically to treat
rheumatism, stiff neck, hemiplegia, and various nervous system disorders.Mahanarayan oil is selected for the massage
treatment when the sinus blockage is extreme; narayan oil is otherwise
selected.

For maximum effectiveness, the oil is applied warm (which is more
comfortable, more fluid, and more able to transport the herb ingredients into
the skin than cold oil) to specific points on the face that are the key areas
of circulation.These points, called marma points, have been described in the
early Ayurvedic literature.They are
much like the acupuncture points of Chinese traditional medicine, and, in fact,
one can massage both the Indian marma points
and Chinese acupoints with good effect.

Marma points are
juncture points (4, 5), rather than points along meridians as found in Chinese
medicine.There are a total of 107
critical marma points on the body,
divided into five groups: muscle (11 points), vessels (41 points), ligaments
(27 points), bones (8 points), and vulnerable joints (20 points).There are 11 points on each leg and each arm
(total of 44), 12 in the region of the chest and abdomen, 14 on the back, and
37 in the region of the neck and head.These points are valuable treatment sites, and, according to traditional
understanding, if the junctures are physically damaged it can have significant
negative health impact—in some cases, causing death.As has occurred with Chinese acupuncture points, the basic set
has been expanded by some practitioners; some, such as Frank Ross (6), have
advocated a complete combining and integration of the Chinese and Ayurvedic
points.

A few drops of oil are sufficient to provide herb extractives and
lubrication for the massage.After the
facial points (about a dozen or so) are massaged, the oil is spread across the
entire face in broad strokes.The
massaging of the marma points and the
whole face stimulates the body to eliminate accumulations.It helps the dhatus—the structures which hold onto substance—to release.It calms and regulates the vata.For an illustrated guide to the basic facial massage, see Johari’s
recent publication on Ayurvedic massage (4).

To enhance the action of this massage, the person being treated
is kept comfortable by placing a hot water bottle under the neck, on the
abdomen (over the intestines), and on the feet.The heat has a relaxing effect and promotes circulation.Further, after applying the oil each time—a
process that is repeated three times—a heated towel is placed on the face,
helping the blood vessels and pores to expand and accept the herb ingredients.

NASYA: NASAL INHALATION OF HERBS

After two applications of the oil to the marma points and to the face as a whole,
a few drops (typically 5) of medicated oil is placed in each nostril (the
person being treated inhales the oil).This portion of the treatment is known as nasya.The hot water bottle
under the neck assists the person in comfortably extending the neck so that the
nose points up and back, allowing the oils to flow towards the sinuses.For the treatment of sinus congestion, a
typical medicated oil is calamus and ginger extract in sesame oil.This oil strongly opens the congested
tissues of the sinuses and breaks up the phlegm (in the event that a person has
a feverish condition, cooling coconut oil is sometimes used to replace sesame
oil; when the oils are not available, calamus powder can be inhaled as a
snuff).Following this, there is the
third application of oil to the face, and then the excess oil on the skin can
be removed by a warm, moistened towel.

The nasal passages can also be massaged on a daily basis by the
individual suffering from sinus problems.For this method, Dr. Lad (7) says “Dip the clean little finger into the
appropriate oil and insert into each nostril as deeply as possible [he cautions
about both sharp fingernails and forceful insertion].The nasal passage is then lubricated through this gentle
massage.Nasal massage helps to relax
the deeper tissues and can be done every day or any time one is under stress....By
this means, the emotions that are blocked in the respiratory tract are
released”For stressful situations,
when the sinuses are not overly congested, one can use brahmi oil (which is
made from gotu kola or bacopa in sesame oil base) or clarified butter (ghee).

Softening the dhatus,
cleansing the overflowing kapha (see
below), and calming the vata, are the
principles of treatment for the symptoms of sinus problems.The treatment, which generally requires
having two oils (one for facial massage and one for use in the nose) and a
minimum of accessory equipment (hot water bottles, warm towels, dropper), takes
about 25 minutes, and it can be self-administered if necessary.Additionally, small amounts of the medicated
nasya oil can be inhaled again at
intervals of several hours to give further relief.

INGESTING HERBS, REGULATING DIET

A key to ultimately eliminating the
problem of sinus congestion is to invigorate the jathar agni.To accomplish
this, one can swallow small amounts of herb combinations in the form of simple
powder (which can be encapsulated or tableted for convenient
administration).The most common
treatment for dampened digestive fire is the powder known as Hingushtaka, a
spicy blend of asafoetida (Ferula
asafoetida), ginger, black and long peppers, and other herbs.A modification of this formula, called Shivakashar Panchana, is made by adding
haritaki (Terminalia chebula) and a
small amount of sodium bicarbonate, and is selected when there is evidence of
obvious lung weakness, such as asthma and bronchitis, when rales are heard
through a stethoscope.Either formula
will treat indigestion, gas, bloating, and accumulation of ama, the unusable substance that arises when food is not fully
digested.For those who are sensitive
to spicy herbs (such as persons with ulcers), an alternative formula can be
used, such as the combination of licorice and turmeric.Licorice pacifies the overexcited fire (pitta vitiation), while turmeric
smoothes and promotes the essential digestive fire (agni).The combination of
these two herbs is used to treat hyperacidity, excessive appetite, irritation
and inflammation of the stomach and esophagus.

The total treatment for the sinus problem is to increase the
digestive fire, penetrate the areas of blockage, and eliminate the accumulation
by regulating the doshas and
modifying the dhatus.To retain the benefits of this treatment,
one should be careful in eating habits to avoid weakening the digestive
fire.According to Ayurvedic
principles, one should avoid chilled foods and foods that are classified as
having a cold nature, as these will further reduce the digestive fire while
contributing to the vata
imbalance.One should also minimize
phlegm-increasing foods: milk products and fatty meats, such as pork and lamb,
are examples.These foods can
exacerbate the kapha accumulation in
the head.And, of course, one should be
careful to avoid irritating the sinuses with smoke, chemicals, or dust.

In this article, one of the most common patterns for development
of sinus disorders has been presented, with the basic types of therapy to be
applied, using specific examples of massage oils, nasya ingredients, and herb/diet suggestions.For an individual, one must check to see
that this pattern is an appropriate depiction, or else adjust the treatment
details correspondingly to the results of the analysis.Dr. Vinod Verma (1) presents some
alternative approaches for sinusitis, such as jel neti, the yogic method of sinus cleansing by pouring water or
milk into the nostrils, and the inhalation of highly aromatic mixtures (e.g.,
eucalyptus, menthol, camphor, lavender, anise).As one becomes familiar with the basic concepts of Ayurveda,
health problems due to imbalances in the body can be detected before they
become severe and can be treated easily through herbs, diet, and lifestyle
modifications, rather than pursuing an endless course of drugs and surgery.

ACKNOWLEDGMENT

The treatment method for sinus disorders
described in this article, and much of the explanation for its functions, is
based on information provided by Kim McCarthy, a massage therapist specializing
in Ayurvedic medicine; McCarthy practices and teaches in Portland, Oregon. I
wish to thank Husaini Ali, of Universal Medicaments, and Dr. K.S. Kundley, of
the Poddar Ayurvedic Hospital, for providing suggestions about the treatment
methods, materials used, and Ayurvedic principles, some of them outlined
elsewhere (3).